Healthcare Provider Details

I. General information

NPI: 1376167833
Provider Name (Legal Business Name): DIEU CHAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 W INDIAN SCHOOL RD
PHOENIX AZ
85031-2420
US

IV. Provider business mailing address

2825 E FRAKTUR RD
PHOENIX AZ
85040-3767
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-4030
  • Fax:
Mailing address:
  • Phone: 714-721-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024441
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: